Game theoretic approaches have been applied to management of antibiotic resistance 8 and control of agricultural pests, 9 as well as cancer progression 10 and treatment. In evolutionary games, 7 the players inherit rather than choose their strategies, and their payoffs are survival and proliferation. Although initially focused on conflict 4 and cooperation in economics, 5 Maynard-Smith and Price 6 pioneered its application to evolutionary dynamics. Developed by Von Neumann and Morgenstern, 1Nash, 2 and others, 3 game theory describes the strategies (choices), payoffs (consequences), and dynamical interactions involving both individuals and populations. The physician-predator can also “evolve” in the sense that he or she can vary treatments over time.Ĭontests such as between the physician and cancer cells can be framed mathematically using game theory. They respond to treatment by evolving effective strategies of therapy resistance. But, for most metastatic cancers, extinction is not achievable because the cancer cells are active “players” in the game. Cure occurs if therapy drives the cancer populations extinct. Therapy options represent the physician’s strategies. Herein, we frame cancer treatment as a contest in which the physician enters a predator-prey–like game with the patient’s cancer cells. Without fundamental changes in strategy, standard-of-care cancer therapy typically results in “Nash solutions” in which no unilateral change in treatment can favorably alter the outcome. Furthermore, by changing treatment only when the tumor progresses, the physician cedes leadership to the cancer cells and treatment failure becomes nearly inevitable. By repeatedly administering the same drug(s) until disease progression, the physician “plays” a fixed strategy even as the opposing cancer cells continuously evolve successful adaptive responses. Current treatment protocols for metastatic cancer typically exploit neither asymmetry. (2) It has a distinctive leader-follower (or “Stackelberg”) dynamics the “leader” oncologist plays first and the “follower” cancer cells then respond and adapt to therapy. Cancer cells, like all evolving organisms, can only adapt to current conditions they can neither anticipate nor evolve adaptations for treatments that the physician has not yet applied. This game has 2 critical asymmetries: (1) Only the physician can play rationally. One of the treasures of the Reformed heritage is an emphasis on theological education, constant learning, and the life of the mind.We investigate cancer treatment as a game theoretic contest between the physician’s therapy and the cancer cells’ resistance strategies. We believe churches flourish when both leaders and members engage in thoughtful theological reflection. The goal is for more people to know - and apply - God’s Word in daily life. We offer curricula to equip leaders to teach the Reformed faith in their congregations. The ECO Polity, in The Constitution, outlines our behavioral and theological essentials and requires that all officers “receive, adopt, and be bound by” these essentials tenets. As a covenant community, our unity derives from a clearly-articulated theology that is Christ-centered, Reformed, and evangelical. We affirm that theological consensus around certain essentials is foundational for a healthy denomination. The goal is not to be same-minded, but like-minded. One of the founding principles of ECO was uniting pastors and congregations around a common theological core.